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Veteran Claims Intake Form
Contact Information
First Name
Last Name
Email
Phone
Service Branch
-None-
Army
Air Force
Marines
Navy
Claim Info
Please complete as much as possible.
Urgency
-None-
Standard
Rush
Claim Status
-None-
New
Submitted
Denied
Claim Type
-None-
Initial
Appeal
Supplemental
Number of Conditions
List Conditions
Records and Documents
Claim Decisions and Blue Button Medical Records
Requested Call Date and Time
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AM
PM
Medical Record Size
-None-
Few Files
Dozens of Files
Complete File
Blue Button and Decision Records
Browse
Please merge documents into one file.
Package
-None-
Basic ($49–$79)
Multi ($99–$149)
Complete - $299
By submitting this form, you agree that VetLetters.com may collect and use the information you provide to review your claim. Your data is kept confidential and used only for the purpose of assisting with record analysis and claim support. Our services are educational and advisory in nature and do
not
constitute legal advice. We are not attorneys or accredited VA representatives. Submitting this form does not create an attorney-client relationship.
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